Niu Niu was a very cute little girl, everything was normal after birth, and her father and mother were very happy looking at the cute little one. However, after the child reached the age of one month, her mother noticed that the child’s face gradually turned yellow, and she was examined at the social health and neighboring hospitals for breast milk jaundice. After taking the above measures, the child’s jaundice did not improve, but the skin jaundice worsened, the sclera of the eyes also began to yellow, the stool was white, the urine was dark yellow, and some doctors considered the child to be congenital biliary atresia, the prognosis of this disease is very poor, later need to replace the liver to save the child’s life, it is recommended to go to a major hospital for examination as soon as possible. The father and mother were very anxious and brought the baby to Shenzhen Children’s Hospital. After detailed questioning and careful examination, Deputy Director Wang Bin applied for an ultrasound examination of the child and finally told the parents that the child was suffering from common bile duct dilatation, not biliary atresia, and did not need liver replacement treatment, and that the child’s future quality of life would be the same as that of a normal child through surgery. But now the child needs to be hospitalized for further examination and treatment. Shenzhen Children’s Hospital General Surgery Ward Wang Bin The deputy chief physician in charge of the consultation after hospitalization told the child’s parents that the child’s disease is called bile duct dilatation, commonly known as common bile duct cysts, generally divided into cystic and shuttle type two. The incidence of girls is significantly higher than that of boys, with a ratio of about 4:1. Its main manifestations include abdominal pain, yellow staining of the skin and sclera, abdominal masses, and fever and vomiting when combined with infection. Once the disease is diagnosed, surgery should be performed in time. Delayed surgery not only increases the pain of the child, but also increases the risk of biliary ductitis, pancreatitis, rupture of the cyst, and even cirrhosis of the liver and even cancer if left untreated, which seriously endangers the health of the child. The diameter of the cyst is only 0.8cm, but the lower end of the cyst has bile sludge deposited to form gallstones, blocking the exit of the bile ducts, preventing bile from entering the intestine and accumulating in the liver. The child will have yellow skin and sclera and white stools. Usually the child’s blocked bile ducts can be unblocked after anti-inflammatory and cholestatic treatment and the jaundice will subside. The surgery will be very safe when the child is about half an age and the width of the common bile duct is 1.0 cm. After a week of anti-inflammatory treatment, the child’s stools gradually turned yellow and the skin jaundice subsided. The ultrasound examination showed that the width of the common bile duct was 0.7 cm and the bilirubin index was decreasing, indicating that the treatment was effective. After discharge, the child’s condition was still normal, but a week later, the stool became white again, and the jaundice worsened, so he was admitted to Children’s Hospital after contacting Director Wang. The above situation indicates that the child must be treated surgically. But will the 0.7cm anastomosis cause postoperative stricture? If stricture occurs, only a second hepatic hilar-jejunostomy can be performed, which has many complications and will have a significant impact on the child’s future life. Should we choose to remove only the common bile duct stones or to perform radical surgery for common bile duct dilatation? Should I choose open surgery or laparoscopic surgery? The child was only 2 months old, could such a small child tolerate the effects of prolonged pneumoperitoneum, and how difficult was the 0.7 cm anastomosis to operate microscopically? A series of questions were put in front of us, and we knew that this was a very difficult child. After the discussion of the whole department, it was clear that the child was suffering from common bile duct dilatation and had to undergo resection of the common bile duct cyst and Roux-Y anastomosis of the common hepatic duct and jejunum, and that a simple choledochotomy could only relieve the obstruction and a second radical surgery would be needed in the future. 0.7 cm anastomosis should not cause stricture if operated properly, but it was difficult to operate. The choice of open surgery or laparoscopic surgery was based on the technical ability of the surgeon in charge. Dr. Bin Wang, the deputy chief surgeon in charge of the surgery, recommended a minimally invasive surgery for the child. On the morning of July 25, 2011, the child was wheeled into the operating room. After 3 and a half hours of surgery, the child was successfully operated on laparoscopically for a radical choledochal cyst, with the cooperation of the two attending physicians, under the personal supervision of Deputy Director Wang Bin. After the operation, Dr. Wang Bin, the deputy chief surgeon, said, “Choledochal cyst surgery is a difficult operation in the field of pediatric surgery because the common bile duct is adjacent to the hepatic artery, gastroduodenal artery, portal vein, duodenum, pancreas and other important blood vessels and organs, and damage to any of these tissues will lead to poor recovery and even serious complications. Moreover, choledochal cysts contain a rich vascular network, which usually involves some intraoperative bleeding and requires proper postoperative blood transfusion for recovery. Therefore, this surgery requires a high level of human anatomy and surgical technique from the surgeon in charge. The traditional open surgery method is very disturbing and traumatic to the abdominal organs of the child, and the postoperative pain of the child is heavy and the recovery is slow. Laparoscopic choledochal cyst surgery is the same operation performed through laparoscopic equipment, which greatly increases the difficulty of the operation and places higher demands on the technical level of the surgeon in charge, making it difficult for most hospitals to perform this procedure. However, through this fine surgical operation, there is less interference with the abdominal organs of the child, and due to the magnification of the imaging system, the anatomy is clear, hemostasis is better, intraoperative bleeding is minimal, and in general, no blood transfusion is needed during and after the operation, and the child’s postoperative pain is significantly reduced and recovery is significantly accelerated, with many significant advantages such as light trauma, less pain, faster recovery and shorter hospitalization. This procedure also leaves only four small holes in the abdominal wall and no obvious scars after healing, which is especially important for female children. We have been able to perform this type of surgery from 6 hours at the beginning to an average of 3.5 hours at present, with the fastest being 2 hours and 20 minutes, which is about the same time as conventional open surgery, but with obvious advantages.” Director Wang went on to say, “Niu Niu’s surgery today was done in a very timely manner, the child’s liver is obviously enlarged, basically flat umbilicus, the liver color is black, bile is obvious, but there is no manifestation of cirrhosis yet, after cutting open the bile ducts there are many sediment-like stones overflowing, and then there is golden bile discharge. If the child delays and cirrhosis develops, the only way to save the child’s life is by liver replacement surgery. Today’s surgery went very well, with about 10 ml of intraoperative bleeding. There are certain reasons why we chose minimally invasive surgery for our child, and we have certain technical guarantees to perform this surgery. We have performed 30 laparoscopic choledochal cysts in the past year and have gained a lot of experience in the treatment of choledochal dilatation. We once performed a minimally invasive surgery on a 2-month-old child with a common bile duct cyst with good results. We have recently performed laparoscopic treatment of biliary atresia with hepatic hilar-jejunostomy in such children, all 2 months in size, and we have achieved a very successful experience with anesthesiologists in surgery, anesthesia, and resuscitation, with no complications such as hypothermia or difficulty in circulatory resuscitation in the children we treated. In addition, the magnification of the lumpectomy allows for a clearer surgical view, making our anastomosis more precise and reliable.” After more than 10 days of treatment, Niu Niu’s jaundice completely subsided, and her liver function and bilirubin indicators dropped rapidly, and she was discharged from the hospital. After another re-check in January, all biochemical indicators were completely normal, and Niu Niu is now a completely normal child.